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Challenges to AMS in the region and potential solutions

Despite the established benefits of ASPs in reducing inappropriate antimicrobial use and resistance, their adoption in the Gulf Cooperation Council (GCC) hospitals remains low.

The adoption of ASPs in hospitals in the region can be facilitated or hindered by a range of institutional/hospital and individual factors.

Table detailing individual and hospital barriers. Individual barriers include lack of up-to-date knowledge regarding appropriate antimicrobial use and resistance, lack of time to perform the required investigations, and fear of patient's complication. Hospital barriers include lack of expertise such as infectious disease specialists, lack of education and training events regarding appropriate antimicrobial use and resistance, and lack of microbiology resources.

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Lack of funding for ASPs and initiatives is often determined by the ministry of health at government level, and this was also reported as a barrier to adopting AMS in hospitals.

Recommendations for implementation of stewardship in the Middle East highlighted the importance of developing and updating local antimicrobial prescribing policies and using collaborative interdisciplinary approaches for success.

There are similarities in the region which can to be taken into consideration:

Overview of similarities in the region that can be taken into consideration

  • Resistance is increasing across the region

  • Variations across hospitals are marked

  • Limited data on resistance and large variations in estimates reflect poor data quality

  • Standards of care and service improvement

  • providing support to staff:

  • Accreditation, laboratory standards and procedures need to be consistent

  • Information technology (IT) is needed to strengthen ASP

  • Unified MDR guidelines are needed (low availability)

  • Data differentiating community-acquired and hospital-acquired resistance needed

  • Data on antibiotic consumption is known but access may be restricted

  • Integration of animal, marine and human sectors for ASP is vital

Specific challenges for the region:

  • Population dynamics

  • Health system growth and funding

  • Cultural and social practices regarding disease and medication use

  • Regional conflict and refugees (de Smalen et al., 2017)

Therefore, ASP in the region needs to take region-specific factors and wider global guidance into account.

Although there are many similarities, variations exist within the region.

List detailing he issues that had the greatest impact on regional collaboration. These include: lack of data/fragmented data, optimisation of electronic systems, lack of cooperation, common guidelines and pathways, and need for clinical governance.

These variations in the challenges to managing multi-drug resistant organisms (MDRO) suggest the need for tailored strategies per nation, targeting the most important risk factors for resistance and poor adherence to ASP guidelines (where available). Intra-regional variations can limit the potential to implement guidelines consistently and may pose barriers to cross-regional cooperation. Solutions and actions need to appreciate the intra-regional variation in MDRO management, based on analysis of barriers to treatment.

Let us know in the comments:

  • Which challenges do you face in your clinical setting?
  • Have any of the points made above surprised you, if so which one?

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This article is from the free online course:

Antimicrobial Stewardship for the Gulf, Middle East and North Africa